Arterial dissections occur when there is a tear or damage to the inner wall or lining of an artery.
Dissections happen most often in the aorta (the major artery carrying blood away from the heart), the carotid artery (a neck artery carrying blood to the brain) and the vertebral artery (an artery in the back of the neck that carries blood from the heart to the back part of the brain).
Dissections in these arteries can lead to serious health problems, including heart attack and stroke.
The causes vary depending on the type of dissection, but a common cause of dissection is trauma to the area where the affected artery is located. Untreated high blood pressure and aortic aneurysms (particularly aneurysms involving the ascending aorta) can also cause aortic dissections.
Risk factors will vary somewhat depending on where the dissection is located. Some common risk factors include:
- Atherosclerosis (hardening of the arteries)
- Ascending aortic aneurysm
- Marfan syndrome (connective tissue disorder that weakens the artery wall)
- High blood pressure
Symptoms will vary based on the type of dissection – for instance, aortic dissection symptoms include severe chest or back pain that is often described as a "tearing" sensation that may move down the back and into the arms and legs, while a carotid dissection is often marked by neck pain and possibly vision problems. Symptoms that may appear as a result of any arterial dissection include loss of movement or sensation in any body part that may resemble the symptoms of a stroke.
The diagnostic tools used will depend on the type of suspected dissection. Commonly used diagnostic procedures include:
- Computed Tomography (CT) scan: X-ray views of the arteries are taken to determine if there are any areas with tears or other damage and to evaluate blood flow through the arteries.
- Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA): Radio waves and magnetic fields are used to show areas of poor blood flow. A patient may be injected with a contrast material – similar to a dye – to make blood vessels more visible.
- Angiography: A dye is inserted into the arteries through a catheter, then an X-ray is taken to show how blood flows through the arteries and whether any arteries are torn or otherwise damaged.
- Ultrasound: The ultrasound's high-frequency sound waves provide the doctor with a picture of the blood flow in the arteries and help determine whether there are any tears or damage.
- Echocardiogram: Used to detect the presence of an aortic dissection, an echocardiogram uses sound waves to create an image of the heart and the aorta as it emerges from the heart. Aortic dissections in this location can be diagnosed rapidly with an echocardiogram.
Surgery to repair the tear in the artery wall is sometimes required, particularly with dissections involving the ascending aorta which emerges from the heart.
Most other dissections can be treated with medications, especially those that lower the blood pressure and heart rate. This type of medical treatment allows the dissection to stabilize and sometimes heal spontaneously. Stents and stent-grafts also have been shown to be useful in the treatment of certain dissections.
UVA is a national leader in the use of stent-grafts to treat aortic dissections and is a regional center for patients with any arterial dissection, particularly aortic dissections.